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universal health care

I just visited a high school friend who has worked almost thirty years delivering health care. She’s been on TDI and COBRA for almost the last year, slowly recovering from disabling health problems of her own.

She’s trying to figure out how to navigate the insurance maze that confronts her as the COBRA runs out.

Although health reform means that she cannot be denied for a pre-existing condition, the insurance she could buy is unaffordable. She was always sensible with money when she was working, but a year with no paycheck has put her in a crisis.

These kind of problems burden people with endless paperwork and errands to run when they are sick, and unforseen expenses when they can’t work.

She said that a relative of hers has a similar illness, and they compare treatment. He is getting good care, similar to hers. He has government health care. He lives in Hungary.

If she were just a few years older, she’d be on Medicare. If her military service fell into the right category, she’d be able to use the Veteran’s Administration.

Right now, she needs professional help. Not just to treat her illness, but to find out how to pay her medical expenses.

She’s one of the many people who would use a public option, Medicare for all, a single payer system that our parents use.

It’s not cheap or easy, but neither is it cheap and easy to bring a child into the world, raise and educate them, benefit from their skilled labor in the workplace, and depend on their support as a citizen.

I heard people at the Health Care Reform Town Hall’s say that we have no choice but to discard people and let them die when they run out of private insurance and saved cash. Austerity feels so bracing when it’s someone else making the sacrifice.

I don’t know what’s Hungarian for ‘yes we can’, but if they can, we can.

THE GOP’S EMERGENCY-ROOM ARGUMENT LIVES…. I’d hoped we would hear the argument much less after the Affordable Care Act became law, but the notion that the uninsured can just rely on emergency rooms hasn’t gone away quite yet.
Here, for example, was Virginia Gov. Bob McDonnell (R) on Fox News the other day:

“The fact is a lot of people that don’t have insurance are getting [care] right now. They’re not denied in the emergency rooms. They’re generally not denied by doctors. It’s not a pretty system, but the idea that people are not getting health care particularly for critical needs is just — is just not the case.”

This is strikingly wrong. For one thing, doctors in private practice nationwide tend to take on patients with insurance. For another, all McDonnell has to do is spend a few minutes at a free clinic someday to realize all kinds of families in need go without much-needed care every day, in Virginia and elsewhere.
But it’s that darn emergency-room argument that needs the most help.

Let’s set the record straight. It’s true that under the previous system — before the Affordable Care Act passed — if you’re uninsured and get sick, there are public hospitals that will treat you. But it’s extremely expensive to treat patients this way, and it would be far cheaper, and more medically effective, to pay for preventative care so that people don’t have to wait for a medical emergency to seek treatment.
For that matter, when sick people with no insurance go to the E.R. for care, they often can’t pay their bills. Since hospitals can’t treat sick patients for free, the costs are passed on to everyone else.

Good points. Comparing the emergency medical system to primary care is like comparing the fire department to a smoke alarm. You don’t neglect fire safety just because you know the firefighters will try to save your life and property. A water-soaked ruin is not a good outcome.

I’m always hearing that the health care crisis is caused by hypochondriac Americans running to the doctor every five minutes. I don’t see that in the community. I more often see stories like this–

It Was Benign, but Almost Killed Him
William Siewert almost died from an enlarged prostate.
Not prostate cancer, just a “benign” enlarged prostate. He is yet another example of the people who fall victim to our currently broken health care system. He agreed to share his story in the hope that someday cases like his would be rare exceptions.

William Siewert lost his job and insurance. He could have been treated with a daily pill, failing that he could have had routine surgery. Instead, with no regular doctor he could afford and just the emergency room, he ended up with kidney failure. The pain and suffering he endured in the year it took to ruin his kidneys I can’t imagine. The cost of his care has now run up to several hundred thousand dollars.

Ironically, there is a special government program for kidney failure. The discovery of dialysis, in a more confident America, struck politicians as the gift of life, and they voted for Medicare to cover kidney disease.

But more people on dialysis is the last thing our country needs. The point where intervention is needed is before the person’s body is trashed. I’ve seen people end up on dialysis because of untreated diabetes– it’s heartbreaking when it could have been prevented.

I don’t think most Americans really want to follow the model of the firefighters who stood around watching a house burn because the owner hadn’t paid a fee. But that is what we’ve been doing to human beings.

Sept. 28, 2009 | The day after this country elected Barack Obama its 44th president, a doctor told me I’d inherited from my father a rare form of cystic kidney disease and that I was already in renal failure. Beyond the devastation I felt on hearing this news, and despite having health insurance, my greatest fear in those first, foggy days was one that haunts millions of Americans. I was more terrified of being dropped or denied treatment by my insurer over some minuscule technicality than I was of facing the disease. After four years of progressive activism, delivery of Obama’s campaign promise of universal healthcare suddenly became very personal and urgent rather than simply a political goal for me.

Veterans, Medicare, Medicaide and a few select conditions will get you health security. We already know how to do it, we just need political will to replace a fragmented system that loses information and leaks money with a regulated system, a strong public option, and a determination to insure all Americans.

I had a lot of arguments with the anti-reform people while I was holding a sign outside three of the Town Hall meetings last month. I sought common ground in the proposal that no one should suffer or die from lack of health care. The response was that people make ‘bad choices’ and stuff happens.

I had pointed out that young people out of school and not yet in a good paying job are especially likely to lack health insurance. Americans are dying unnecessarily. Working people are risking their health and lives because they can’t afford insurance and they can’t afford medical bills. How do you make ‘good choices’ when there are none? Kimberly Young gambled on her youth and health and lost, dying of the flu…

Her roommate’s mother said Young worked several jobs, none of which offered insurance. She eventually went to a public hospital’s emergency room after showing signs of kidney failure and dehydration. In critical condition, she was soon after transferred to another facility, where she died.

The people I argued with, who enjoyed their government benefits but rallied to prevent others from getting the same were showing us one path we might follow. Limited vision, harsh judgment on anyone who falls out of the system, and a deep fear that they might end up excluded too. In a new millennium we can look back on Charles Dickens’ world and see our own reflection.

I can’t understand people who seem willing to hold up health care for millions of uninsured Americans for the fear that some undocumented people might slip through the cracks in the system and get seen by a doctor. Joe Wilson claims he was being ‘spontaneous’ when he shouted at the President, but in the cold light of day he’s a hero to people who blame every social problem on ‘illegals’.

So when the Congressman does a fairly routine motion of granting a reprieve to a man who ignored a deportation order, he must be using some criteria for making an exception. The case is surely deserving and the intervention is not especially unusual, but why this undocumented immigrant and not someone else? No one’s talking.

Wilson may have a conflict of interest [on immigration], however. Two months before he heckled Obama, he introduced legislation to keep Sainey Fatty, an illegal immigrant from Gambia, in the country. Fatty came to the U.S. for school in the early ’90s and lived here for seven years while under a deportation order, according to his friend Bill Cook’s blog.

In his bill, Wilson asks Congress to forgive Fatty’s immigration woes, drop the deportation order against Fatty and allow him to remain in the country legally.

Wilson’s communications director Ryan Murphy told Raw Story in an e-mail that “Congressman Wilson does not support illegal immigrants getting access to a government taxpayer funded health insurance program.” He did not respond to questions about what motivated Wilson to keep Fatty in the country or whether Wilson supports Fatty’s ability to receive medical care in the U.S.

Is it just harder to be hard-line when it’s an actual person and not some abstract ‘illegal’? I’d be surprised if Sainey Fatty did not have a compelling personal story and dire need to stay in the US. So Congressman Wilson should just explain why he made an exception, and what he considers good reasons to grant amnesty to certain people. It would humanize this whole discussion and help him shed the extremists who are making ‘illegal’ this decade’s racist target.

At the Warwick Town Hall I had a guy yelling in my face–TORT REFORM!!!

It’s pretty funny, actually, that so many people are fired up to limit their options for compensation. They must be the same people who opposed taxing Paris Hilton’s inheritance. All those non-millionaires fighting the ‘death tax’.

In my researches into the Salem witch trials, I discovered an interesting cultural trait. The Puritans sued each other a lot. Launching lawsuits was a part of our culture before we called ourselves Americans. The Pilgrims were dragging each other into court before the first apple trees were planted to make the first American apple pie. God, we’re obnoxious.

Suing is a lousy way to settle differences– it makes both sides look bad. There’s a time and place for it, but not as a first recourse, and not for profit.

The threat of lawsuits hangs over anyone who works with people, especially in the medical field. Sometimes it makes us defensive, it feeds into a work culture that values competence and has a hard time admitting the existence of human error. I don’t think the pressure makes us give better care. Some statistics show that the cost of malpractice is not a significant part of health care costs, but it depends on who you are. I pay a modest yearly fee for malpractice insurance– if I was a midwife I might have to choose between practicing my specialty and making a living. The costs fall very heavily on some doctors and nurses.

The present system doesn’t protect patients either. I have heard stories from people who I believed had a valid cause for complaint. But they didn’t sue. They were sick, maybe they were old. It takes a lot of energy to go after someone. I think that most people who are harmed by medical errors just suffer. The present system rewards a few people who win a lawsuit, and makes their lawyers rich, but doesn’t do much for the rest of us.

Administration officials said Obama’s order will encourage states to experiment with programs that reduce litigation and promote patient safety. Preventable medical errors are estimated to cause 44,000 to 98,000 deaths a year.

One kind, known as “early disclosure” or “Sorry Works,” encourages doctors and hospitals to own up to their mistakes, apologize to patients and their families, and offer restitution as well as a pledge of corrective action to prevent other patients from being harmed by the same mistake.

Here’s another approach, check out the numbers–

The second type of program requires would-be malpractice plaintiffs to go before an expert before they proceed to court. The expert — it can also be a panel — acts like a grand jury to weed out frivolous cases. Gordon said that since his state of Tennessee adopted such a requirement last year, the number of malpractice cases filed has dropped by 69 percent. And malpractice insurance premiums are expected to decline by 2.5 percent this year.

I love that. The insurance companies have 69% fewer malpractice cases and they drop the fees 2.5%. Maybe there are some cost savings to be had by taking them out of the middle of things.

I think we could do a lot better than the present system. Patients deserve protection from mistakes and malpractice, and compensation for their losses. Practitioners shouldn’t have to practice defensive medicine.

But this is a side issue to the real offense– a crime, not a tort. Americans are going bankrupt, getting sick and dying for lack of affordable health care. Tort reform if done right will improve care and help cut costs, but it is only a small part of the picture. We need a plan that makes health care accessible to all Americans.

Having spent three Town Halls nose to nose with people who told me in one breath that they were Christian and in the next that people who made ‘bad choices’ could just go ahead and die–well I find this really refreshing. Godspace takes the point of view that it’s contrary to Christian values to deny health care to the poor. They must have been reading that subversive New Testament.

Having trained as a medical doctor and worked in countries with both socialized and privatized healthcare I am very aware of the pros and cons on both sides. But I must confess that I have never worked in another country where people are afraid of going bankrupt because they get sick. Evidently in the US half of all bankruptcies are due to illness. Nor have I been in a country that thinks it has the best health care system in the world yet allows eighteen thousand people to die each year because they are uninsured. And the US has the highest infant mortality of any Western nation. These factors alone give me cause for concern so I am delighted to see that other far more able voices than mine are being raised about this issue.